[CIS-PAGID] PCP pneumonia and steroids

[Pere Soler Palacin]

Dear Jason, we are only using steroids in these cases with severe hypoxemia with good results in SCID patients. 



Yours, 



Pere 



Pere Soler Palacín, MD, PhD 
Pediatric Infectious Diseases and Immunodeficiencies Unit.             
Vall d'Hebron Hospital. 
Passeig de la Vall d'Hebron 119-129. 
08035 Barcelona. Spain. 
Tel: 0034934893140. Fax: 0034934893039. 
E-mail: psoler at vhebron.net ; 34660psp at comb.cat   Web: www.upiip.com 

  


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Pere Soler Palacín, MD, PhD 
Pediatric Infectious Diseases and Immunodeficiencies Unit.             
Vall d'Hebron Hospital. 
Passeig de la Vall d'Hebron 119-129. 
08035 Barcelona. Spain. 
Tel: 0034934893140. Fax: 0034934893039. 
E-mail: psoler at vhebron.net ; 34660psp at comb.cat   Web: www.upiip.com 

  


No imprimir aquest correu ajudarà a preservar el medi ambient. 
Si vostè no és el destinatari del missatge, o l'ha rebut per error, si us plau notifiqui-ho al remitent i destrueixi el missatge amb tot el seu contingut. Està prohibida la distribució no autoritzada del contingut d'aquest missatge. 

No imprimir este correo ayudará a preservar el medio ambiente. 
Si usted no es el destinatario del mensaje, o lo ha recibido por error, notifíquelo por favor al remitente y destruya el mensaje con todo su contenido. Está prohibida la distribución no autorizada del contenido de este mensaje. 

----- Mensaje original ----- 
De: "Jason W. Caldwell" <jcaldwel at wfubmc.edu> 
Para: pagid at list.clinimmsoc.org 
Enviados: Jueves, 19 de Mayo 2011 15:10:04 
Asunto: [CIS-PAGID] PCP pneumonia and steroids 




Good morning, 



I have a 5 month old male child in the hospital who I suspect has X linked hyper IgM syndrome.  His IgM is 42mg/dL (20-40), IgA <6 mg/dL, and IgG<200mg/dL.  (This has been confirmed by repeat analysis).  His T and B cell numbers are elevated and total lymphocyte count is 14,000.  HIV is negative.  He came in with respiratory distress and has been on 1.5-3 L of O2 by nasal canula since admission on 5/11/2011.  I saw him for the first time on 5/17 and based on the X-ray started he was on Septra immediately.  Yesterday morning a bronch confirmed Pneumocystis.   This morning he saturations are 98% on 2L by nasal canula and he is awake and alert in no distress.  His work of breathing has improved since yesterday. 




Now the question is to give or not to give steroids.  I have reviewed the literature on this question and ID has weighed in on this question, not surprisingly they are absolutely for giving steroids.  I am fully aware that ID is biased by the literature of treating PCP pneumonia in HIV infected patients which is certainly not as clear cut in PCP in non-HIV infected patients.  The final factor is that this young man will be going for evaluation at another center for BMT as soon as he is stable. 



I would appreciate in wisdom that you could share with me about your experiences in this situation. 







Jason Caldwell 

Assistant Professor Internal Medicine and Pediatrics 

Section of Pulmonary, Critical Care, Allergic and Immunological Diseases 

Wake Forest University School of Medicine
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